Citation Nr: 21000719 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 09-47 919 DATE: January 6, 2021 ORDER Service connection for a back disability, to include as due to an undiagnosed illness relating to service in Southwest Asia, is denied. FINDING OF FACT It is less likely than not, that the Veteran’s current back condition was caused by or otherwise related to his active military service. CONCLUSION OF LAW The criteria for service connection for a back disability, to include as due to an undiagnosed illness relating to service in Southwest Asia, have not been met. 38 U.S.C. §§ 1110, 1117, 1131; 38 C.F.R. § 3.303, 3.307, 3.309, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Marine Corps from June 1988 to January 1998, to include service in Southwest Asia. The matter is on appeal before the Board from a June 2007 rating decision. The Veteran provided testimony at a Board hearing before a Veterans Law Judge (VLJ) in June 2014. A transcript of the hearing is of record. That has since retired from the Board. The Veteran was sent a letter in November 2020 explaining that he had the right to another hearing, and he was given 30 days to respond, with the explanation that if no response was received that it would be assumed that he did not want another hearing. No response has been received. Previously, the Board remanded the matter for further development in October 2014. In an April 2016 decision, the Board denied the Veteran service connection for a back disability. The Veteran appealed the April 2016 Board decision to the United States Court of Appeals for Veterans Claims (CAVC or Court). In March 2017, the Court issued a Joint Motion for Partial Remand (JMPR), in which it remanded the issue back to the Board for further development and adjudication. The Board remanded the matter for further development in both June 2017 and November 2018. That development having been completed; the matter has returned to the Board for further adjudication. Service Connection Back Disability The Veteran asserts that he has a back disability that is related to his active military service. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established with certain chronic diseases, based upon a legal presumption, which occurs by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Additionally, service connection may be established under 38 C.F.R. § 3.303(b), when a symptom or symptoms of a chronic disease are noted in service, or within a year of the date of separation from service, and when chronicity is established through a continuity of symptomatology after service. The continuity of symptomatology provision is an alternative method to establishing service connection for the specific chronic diseases listed under 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established on a presumptive basis for a Persian Gulf Veteran who exhibits objective indications of chronic disability resulting from undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). In claims based on undiagnosed illness, unlike those for direct service connection, there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Notably, laypersons are competent to report objective signs of illness. Id. In addition to an analysis of the evidence of record, a recitation of the factual background of this appeal leading up to this decision is appropriate. In November 2006, the Veteran filed an informal claim for service connection for a back injury at L-5, to include as due to “Persian Gulf Syndrome.” A review of the Veteran’s service treatment records (STRs) reflects that at the Veteran’s enlistment examination in November 1987 he denied a history of back pain. On March 5, 1990, the Veteran reported having a backache that had begun around November or December. He had not had any previous treatment and had no recollection of any trauma. It was assessed as a mild lumbar muscle strain, and the Veteran was treated with motrin and bengay, and placed on light duty for four days. He was told to follow up on March 9, 1990, however, the records do not show that he returned for any follow up appointment. On July 25, 1994, the Veteran reported pain in his lower back and between his shoulder blades and had a fever. He was assessed with a viral syndrome, and referred for further evaluation the next day. On July 26, 1994, the Veteran presented himself for further evaluation based upon the preceding days referral. He reported symptoms of back pain beginning about two days prior, and was noted to have mild CVA tenderness. He was assessed with a urinary tract infection, and was advised to follow up in 10 to 14 days for re-evaluation. On August 27, 1994, the Veteran reported lower back pain that had persisted for about two and a half weeks. It was again assessed as a urinary tract infection. On September 6, 1994, the Veteran returned for follow up of his urinary tract infection, and was noted to have lower back pain and mild CVA tenderness. It was explained that the mild lower back pain may resolve, and therefore back pain would not be treated at that time. The Veteran was advised to follow up for later treatment if his back pain persisted. The record does not show that he returned for follow up treatment. At a periodic physical in May 1995, the Veteran specifically denied recurrent back pain, while checking sinusitis, jaundice or hepatitis, broken bones, and arthritis, rheumatism, or bursitis. The implication of this is that the Veteran was willing to report orthopedic problems (such as arthritis) on the medical history survey, suggesting that if he had been experiencing back problems at that time, he would have reported them. The broken bones were noted in relation to his left wrist, and the excision of an ununited fragment. The arthritis, bursitis, or rheumatism was reported in relation to left wrist pain and knee pain when standing for prolong periods of time. However, the examiner noted that the Veteran did not have any medical documentation of arthritis, bursitis, or rheumatism. At the Veteran’s September 1997 separation examination, the Veteran denied recurrent back pain, while he did check having had other issues such as a chronic cough, shortness of breath, head injury, sinusitis, jaundice or hepatitis, broken bones, and attempted suicide. Upon clinical evaluation the examiner noted spine and other musculoskeletal to be normal. The Veteran submitted private chiropractic treatment records from October 1999 to April 2000. In October 1999, the Veteran reported having back, knee, and leg cramps that began in 1988, and that he was still having recurring pain. He noted having had treatment for the condition before by corpsmen. He reported that the condition was due to overuse of his back muscles. He did not check the box next to auto accident, and in relation to major accidents or falls he wrote “N/A.” On an interim report questionnaire from November 1999, the Veteran reported that he gets minor lower back pain two to three times per week, and that the therapy and adjustment relieve his pain and discomfort. He estimated that his condition had improved by 40 percent. On a December 1999 interim report questionnaire, the Veteran noted having mild lower back pain one to two times per week, and that his back had improved to the point of having hardly any back pain. He estimated that his condition had improved by 90 percent. On an April 2000 interim report questionnaire, the Veteran reported that he had little to no back pain, and estimated that his condition had improved by 95 percent. Additionally, he submitted an undated narrative report from a private chiropractor in July 2008. It was noted that the Veteran had presented himself for treatment on August 31, 2007. He complained of lower back pain that had begun two months prior. The history of the Veteran’s injury was explained as follows. The Veteran reported that he had been in a motor vehicle accident (MVA) in 1997, where he had been the driver of a military jeep that was rear ended while stopped at a red light. He relayed having immediate lower back pain on a scale of four out of ten. However, the accident was not reported at that time, and treatment was not provided. He began chiropractic treatment in 2000 with good results. However, in February 2004, he reported that he was in another motor vehicle accident where he was backed into from the front while stopped, and the original lower back pain was aggravated. Afterwards, he sought treatment and was given steroid injections for three months. Due to only minimal improvement from the injections, he also underwent physical therapy which provided good improvement. After an onset of lower back pain in June 2007, the Veteran went to a VA clinic, where he received an MRI and x-rays. An L5/S1 disc bulge was noted. Afterwards, the Veteran began seeing the private chiropractor in August 2007. Anterior-Posterior and Lateral x-rays were noted to have been taken of the Veteran’s lumbar spine. They were reported to show 26 percent loss of the normal lordotic curvature, lumbarization, mild narrowing of the L5/S1 disc height, mild anterior spurring of L5, and moderate posterior spurring of L5. Diagnoses of multiple lumbar subluxations, lumbago, and lumbar IVD syndrome were provided. The chiropractor explained that the Veteran had responded well to chiropractic treatment and had received relief from the original symptoms. However, due to the type of manual labor that the Veteran does daily, his injury would be subject to episodes of exacerbation. The Veteran was noted to work for a cemetery, where his work activities included light to moderate labor on a daily basis. The Veteran’s VA treatment records reflect a rheumatology note from September 5, 2002 where the Veteran reported having chronic low back pain for at least ten years, which began while he was in the military and manifested as an occasional slight aching pain in the morning without stiffness that improves with activity. He was noted to work as a marble worker, where he frequently lifted more than 1200 pounds of marble a day. The physician’s impression was chronic low back pain. X-rays of the Veteran’s lumbar spine were done on September 5, 2002, which included lumbosacral spine and SI joint plain films, and were interpreted as normal. X-rays were also taken on June 13, 2007, and the impression was a normal lumbosacral spine without change since September 5, 2002. An MRI of the Veteran’s lumbar spine was also provided on June 22, 2007. The impression was an unremarkable lumbar spine MRI, however, a diffuse disc bulge at L5-S1 was noted. At a rheumatology consult on September 6, 2007, the Veteran was noted to have had numerous radiological studies that were unremarkable. He relayed that he had recently seen a private chiropractor and had undergone a procedure called MyoVision. The VA physician again noted that the Veteran’s x-rays from the VA were essentially unremarkable, while the Veteran reported that his chiropractor had told him that he had two fractured disks in his back, one of which was pinching a nerve. The VA physician’s impression was that the Veteran had low back pain, which was his greatest complaint. He had normal EMGs and radiologic studies through the VA except for an L5-S1 disk bulge. The Veteran’s pain did not appear to be from an inflammatory cause. In June 2009 the Veteran provided testimony at a hearing before a Decision Review Officer, where he reported that he had treatment for his lower back condition a couple of times while he was in service, which he believed to be somewhere around 1989 or 1990 and 1993 or 1994. He noted that when he was really complaining about it was around the 1993 to 1994 time frame, and that at the time he had been told that if it continued or got any worse that they wanted to do a more intensive evaluation and possibly put him on tranquilizers or perform back surgery if anything worse was found. The Veteran reported being in a MVA around September or October of 1997, where the vehicle was totaled. He relayed that the MVA had placed a severe strain on his back, but he had been denied medical treatment by his command because there had been individuals in the car with him that were waiting to go to boot camp. He was supposedly denied medical treatment because if he went to seek medical treatment, then the individuals that had been in the car with him would also have to get medical treatment, which in turn would cause them to be discharged from the military and not be able to go to recruit training or anything. Thus, his command said that if that happened it would reflect on his performance evaluation, which would lead to disciplinary action. He said that it was being held over his head and that he was basically being threatened, and therefore he did not seek medical treatment. He noted that he was discharged a few months later, and in October 1999 he was treated for a lumbar spine condition. It was noted that the Veteran was also in a MVA after military service, where someone backed into him, which twisted his back and basically led to irritating the back injury that he already had. He stated that he went through a series of steroid shots after the accident to try and get the irritation and stuff down. The Veteran underwent a VA back examination in January 2013, at which he reported that he was in a MVA in 1997, where he was rear-ended at a stop light while in a government car. He said that the paperwork was destroyed because he had recruits in the vehicle with him, and that he was not allowed medical care. The VA examiner noted that the Veteran had undergone private treatment with a chiropractor from October 1999 through September 2001. Lower back pain was reported to have flared up again, after the Veteran was in another MVA in 2003. An L5-S1 disc bulge was purported to have been noted then. He received three lumbar epidural steroidal injections after the 2003 MVA. The examiner noted that the Veteran saw another private chiropractor in August 2007. The Veteran was reported to have worked at a cemetery in 2007, where he lifted and set grave headstones, which aggravated his lower back. The VA examiner was asked to answer the question of whether the Veteran’s current lower back disability was at least as likely as not incurred in or caused by the mild lumbar muscle strain in March 1990. The response was “yes it does seem to have originated at that point in time but subsided till current lower back pain with flares that started after 2003 MVA. So, it’s more than likely as not that his present lower back pain stems from [the] MVA in 2003 according to records and chronologic lower back care record.” The Veteran provided testimony at a Board hearing in May 2014, where he reported being in a MVA in August 1997. He relayed that he had to take five potential enlistees up to a lake area that had a track around it to run an initial physical fitness test before they were shipped out to recruit training. After completing the test, they all got back into the government vehicle, which was an Oldsmobile sedan. The trip back to the office was about a mile to a mile and a half from the lake. While they were stopped at a red light, a pickup truck rear-ended them from behind while going approximately 40 miles per hour. The truck did not stop. The government vehicle was totaled, to the point that they were not even able to open the doors initially. It took a bit of work for them to be able to get out of the vehicle. The Veteran stated that he called the noncommissioned officer (NCO) in charge and told him what happened. The NCO came to the accident scene, looked over the vehicle, took the potential enlistees and put them in his vehicle, and called the sergeant major. The NCO took the potential enlistees back to the office, but before he left, he told the Veteran to deal with the police officer and inform him that the Veteran was the only one in the vehicle. The Veteran reported that if he were to inform the police that anyone else was in the vehicle besides him, then the potential enlistees could possibly be discharged, and if that occurred then the Veteran would face punitive actions by the command. Thus, he did as he was told, and the vehicle was towed. He stated that he was not cited for the accident, because it was the other driver’s fault for not stopping at a red light. When he returned to the office, he reported that he was in severe pain in his back and needed to go to the doctor. However, he was told to suck it up, deal with it, and not go to the doctor. He could go home and relax though, which he did. He reported that he continued to be in pain over the next few days, but was told to just take some pain medication. It was reiterated to him that he was not to go to the doctor because if he went to the doctor then the initial enlistees could possibly be discharged, and if that occurred, then he would face punitive actions. He reported that he could not go to the doctor for his back even after the enlistees shipped out and until they completed boot camp. He relayed that he did not receive a copy of the accident report because his sergeant major and the NCO in charge talked with the police and the personnel in charge of the motor pool for the government vehicles to ensure that everything was covered up and that there was not any paper trail. The Veteran reported that at his separation examination he told the examiner that he had been in a MVA, but the examiner told him that because there was nothing in his medical record or anything else to support it that it was not being annotated. After his discharge in January of 1998, the Veteran reported that he began seeing a chiropractor for his back within six months of his discharge. He noted that he had a herniated disc at L5 and a shoveler’s disc at either C3 or C4 in his neck. He said that he learned of the specific disc issues because his chiropractor had taken x-rays and done and examination. It was noted that the Veteran was in an additional MVA in 2003. The Veteran reported that after he got out of the service, he began working for a company assisting in the installation of cultured marble for marble countertops and showers. This was from January of 1998 to September of 2001. He noted that he did not have any problems with his back in performing his duties to begin with, but that it had got to the point that he was moved to the shop where he was grinding, using the geldons, and spreading molds because he had reported having back pain. As previously noted, in October 2014, the Board remanded the issue for further development, to include providing the Veteran with a new VA examination. The Veteran underwent a VA back examination in January 2015, at which he was noted to have very briefly had a lumbar strain in March 1990 without any traumatic origin. The Veteran reported the 1997 MVA, where he was rear-ended while in a government vehicle. Then he was in a MVA in 2003, and a L5-S1 disc bulge was found at that time. He was seen by a private chiropractor and received three steroid injections. He was also seen by the VA rheumatology department and had a normal EMG study in 2007 along with a normal lumbar spine MRI and plain x-ray film results. VA neurology saw the Veteran and he was diagnosed with mechanical lower back pain. He has never had back surgery. The examiner was asked whether it was at least as likely as not that a spine disability was present, caused by, or related to the Veteran’s military service time? The examiner responded that the Veteran had a lumbar strain in March 1990 in service, but it subsided. Then the Veteran claimed he had a MVA in 2003, which the examiner believed was after the Veteran was out of the military. The examiner found that it was more likely than not that the Veteran’s lower back mechanical lumbar strain pattern was currently a result of the 2003 MVA. So, if in 2003 the Veteran was not in the military then it is not as likely service related, but if he was in the military in 2003, then it would have been as likely as not to be related to military service. The examiner stated that they could not make that determination, and that they could not say anything more and would not speculate. As previously noted, the Board denied the Veteran service connection for a back disability in an April 2016 decision. He appealed the decision to CAVC, and in March 2017 the Court issued a JMPR. The Court remanded the issue in part because the medical opinion from the January 2015 VA examination was not based on a review of the Veteran’s current claims folder, and because it contained no rationale for its opinion that the in-service injury subsided. It was noted that when providing an etiology opinion, the examiner noted that the c-file was not received this time, but VBMS notes were reviewed, and the C-file was not necessary again. The examiner had opined that the Veteran had a lumbar strain in service, “but it subsided.” Thus, in June 2017 the Board remanded the issue to obtain an addendum medical opinion to the January 2015 VA medical opinion that was in compliance with the March 2017 CAVC JMPR. Additional chiropractic medical records were associated with the Veteran’s file in July 2007, that included the aforementioned chiropractic records from October 1999 to April 2000 and the undated chiropractors narrative report. Chiropractic records for August 2007 through November 2007 and June 2014 through June 2017 were also submitted, which in general showed the Veteran to be undergoing treatment for his lower back pain. The record also noted the Veteran to have been in another MVA in March 2015. A VA addendum medical opinion to the January 2015 VA examination was issued in July 2017. The examiner noted that the Veteran had a mechanical lower back strain in military service. He was diagnosed with mild degenerative joint disease in 2007 and treated with steroid injections and chiropractic treatment. A lumbar disc bulge was the impression provided by the VA rheumatology department in 2007. A June 2007 lumbar MRI was normal, however, the VA neurology department diagnosed mechanical lower back pain. The Veteran had a normal EMG study of his bilateral lower extremities in 2007. There had not been any back surgery ever done up to this point. The Veteran had mechanical lower back pain (strain) in service, and it is not something that would carry over all these years. He was in a MVA and rear-ended in 2003, which injured the lower back. He has continued to complain of lower back [pain] since that time. The examiner did not find it at least as likely as not that the Veteran’s current lower back status was related to military service. Rather, it was related to his 2003 MVA incident. Thus, unless the Veteran was on active duty at that time, the examiner could not appreciate a military time cause and effect. The examiner reported that the Veteran’s medical files and specialty evaluations along with previous C&P exams were reviewed for the addendum. An additional VA addendum medical opinion was issued in September 2017. The examiner reported that a lower back condition of a muscle strain was present during the Veteran’s active duty service time in 1990. The Veteran’s degenerative joint disease of the lumbar spine however was after his time in service, as it was found in 2007 and was after a MVA in 2003. The lumbar strain resolved. The mechanical lower back pain and his mild degenerative joint disease, and a L5-S1 disc bulge is not due to military service. Rather, the examiner found that it is most likely secondary to the MVA after service time so not military service related. As previously noted, the Board again remanded the issue in November 2018. In the opinion the Board found that the prior medical opinions were inadequate for adjudication purposes, to include the 2017 addendum medical opinions. This was because the VA examiner did not discuss the Veteran’s private chiropractic records from 1999, nor did he consider the presence of an undiagnosed illness related to service in Southwest Asian. In addition, the Board noted ambiguities in the rationale from the 2017 addendum opinions, which were found to require further clarification. Thus, a VA medical opinion was issued in May 2019. The examiner noted that the opinion was based upon review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence. The examiner provided a detailed timeline of the medical evidence, to include STRs, private chiropractic treatment records, and VA treatment records. The examiner was asked whether it was at least as likely as not (50 percent probability or greater) that any back disability is due to an undiagnosed illness or medically unexplained chronic multi-symptom illness? The examiner responded no, the Veteran’s diagnoses are lumbar strain from March 5, 1990, and degenerative disc disease of the lumbar spine from June 22, 2007. The examiner noted that the Veteran had reported that he has a herniated disc and was advised to have surgery. This was not noted in any treatment records he supplied and is certainly not noted in the VA treatment records nor on the MRI completed at the VA. A chiropractor’s note is noted to list IVDS as a diagnosis; however, this is not consistent with MRI or EMG findings. The examiner explained that both of the conditions diagnosed are conditions with a clear and specific etiology and diagnosis. The examiner was asked whether it was at least as likely as not (50 percent probability or greater) that any diagnosed arthritis manifested within one year of active duty service? The examiner responded no, and explained that the Veteran had left service in 1998, was not diagnosed with arthritis until 2007, and that there was no objective evidence of arthritis prior to 2007. The examiner was asked whether it was at least as likely as not (50 percent probability or greater) that any back disability had its onset during, or is otherwise etiologically related to service? The examiner answered that the Veteran’s degenerative disc disease was less likely than not (less than 50 percent probability) caused by or a result of military service. The examiner noted that the Veteran contends that he was in a MVA in 1997 that resulted in his military vehicle being totaled. This reportedly happened in a jeep while he was stopped at a red light. The force required to total a stopped jeep would be significant. It is difficult to believe that a military vehicle would be totaled while stopped at a light without a paper trail. The government would have undoubtedly wanted to recoup the loss of a military vehicle from the person that was at fault. The examiner reported the Veteran’s self-report of this to be difficult to accept without corroborating evidence. The examiner noted that the Veteran failed to report a MVA on the October 26, 1999 chiropractic record even though the form he completed specifically asked about MVAs. The examiner also made note of a June 2007 ER visit where the Veteran reported that his back pain stemmed from a MVA in 1998 and not 1997. The examiner reported that the Veteran had been seen once for acute back pain on March 5, 1990, given appropriate treatment, and had been advised to follow-up on March 9, 1990. There was no evidence of follow-up. The Veteran was seen twice in 1994 for low back pain associated with a urinary tract infection. Physical exams clearly document that this was CVA tenderness, and not an orthopedic condition. The veteran was not seen again in the service for back pain following March 5, 1990. This indicates that the March 5, 1990 condition was acute and resolved. The Veteran specifically denied recurrent back pain on May 1, 1995 and September 17, 1997. Certainly, his recall of having back pain in the 1990s would be greater than his recall of that same time frame years later. The examiner noted that the Veteran had reported that he was advised to have back surgery. This was not confirmed in the Veteran’s treatment records. The Veteran also reported that he was told that he had a herniated disc. This is not confirmed on MRI or in the treatment records. The Veteran has reported multiple leg symptoms that he attributes to his back. This is not confirmed on MRI or EMG/NCS. The examiner stated that the Veteran has made many claims without corroborating evidence. In fact, many of his claims contradict documentation in the medical records. The examiner explained that the Veteran’s version of events deviates significantly from the events reported in his records. This kind of discrepancy can call into question the veracity of other facts supplied by the Veteran. It appears that the Veteran may not be the most accurate historian of events that occurred in regard to his back claim. The examiner noted the November 2018 Board remand quoting the following: The July 2017 opinion indicated that mechanical back strain isn’t something that would carry over all these years. However, the examiner did not discuss the Veteran’s private chiropractic records dated between October 1999 and April 2000, in which the Veteran reported continuing symptoms of back and leg cramps since his active duty service. As such, the Board is left to speculate as to whether the Veteran’s symptoms did in fact continue after service and whether current symptoms were aggravated by, rather than a result of, the 2003 car accident. Regarding the 2003 car accident, the examiner’s reports are contradictory. In January 2013, he indicated that the Veteran’s back disability originated in March 1990, but subsided until current lower back pain with flares started after the 2003 motor vehicle accident. This could be interpreted as meaning that the same back injury, dormant since service, was aggravated and reemerged after the 2003 accident. However, in July 2017, the examiner indicated that the mechanical back strain in service is not something that would carry over to the present. In January 2015, he used the term mechanical strain pattern, which suggests a repeated occurrence of such condition, but he did not elaborate on his intended meaning. The examiner opined that after extensive review of the records, the Veteran suffered a strain on March 5, 1990 that resolved. It was noted that the examiner had discussed the rationale previously, but summarized it by stating that the Veteran did not follow-up on March 9, 1990 as directed, and he specifically denied having recurrent back problems on two separate occasions after this. As to the 1999 to 2000 Chiropractic records, the examiner noted that the Veteran failed to report an MVA in the 1999 chiropractic record even though the form he completed specifically asked about MVAs. The chiropractic records from this time are consistent with an acute condition that improved with treatment. This is noted by record of decreasing pain with treatment. The Veteran has been engaged in physically demanding employment and this is the likely cause of the 1999 to 2000 back pain. The examiner concluded that the demands of the Veteran’s civilian occupation combined with the post-service MVA are the most likely cause of his lumbar degenerative disc disease. First, the Board finds that the foregoing evidence does not support a finding that the Veteran’s current back condition is related to his in-service complaints of lower back pain. The Veteran was seen in March 1990 for complaints of lower back pain/strain, at which time he was advised to follow up in four days, which the record does not show that the Veteran ever followed up. Then he was seen in 1994 with complaints of back pain/tenderness that was noted as CVA tenderness and was assessed with a urinary tract infection. He was told after a September 6, 1994 follow-up appointment, that if his back pain persisted then he was to follow-up for further treatment. However, the record does not show that the Veteran followed up. At both a periodic physical in May 1995, and at his separation examination in September 1997, he personally denied recurrent back pain. In addition, based upon the foregoing evidence the May 2019 VA examiner found that the lower back strain the Veteran suffered from in March 1990 had resolved. Based upon the discrepancies between the Veteran’s statements and the medical evidence of record, the Board finds the Veteran’s credibility to be called into question. As to the Veteran’s current back condition being due to a MVA occurring in 1997, the Veteran’s recitation of the MVA itself is questionable. The other driver after rear-ending and totaling a stopped vehicle while going 40 miles per hour drove off, no one was injured at the scene of the accident requiring any medical care, and the police and his commanding officers covered up the accident so that there was no paper trail. Afterwards, the Veteran reported that his back was hurt, but was told that he could not see a doctor because the recruits could get discharged, and that would lead to the Veteran facing punitive actions. While the Veteran argues that he was not allowed to get medical treatment and thus report the accident to anyone while in the service, he could have at least reported having back problems at his separation examination in September 1997. The Veteran argues that he actually reported the MVA and his back problems at his September 1997 separation examination, but that the examiner did not annotate anything because there was nothing in his record to support the allegation. However, the Veteran himself specifically denied recurrent back problems on his report of medical history, while he did note other issues. In addition, the Veteran has reported differing timeframes for the accident. At a June 2007 ER visit, the Veteran relayed that the accident occurred in 1998. At the June 2009 DRO hearing he noted that it happened in either September or October 1997. At the May 2014 Board hearing he stated that it happened in August 1997. After the Veteran got out of the military, he immediately began working in physically demanding jobs that would put strain on his back. His first job was working with marble where he assisted in the placement of marble for countertops and showers. He was noted to have lifted over 1200 pounds of marble in a day. He later worked in a cemetery where he lifted and set headstones. The record reflects that the Veteran began receiving private chiropractic treatment in October 1999, which was a year and ten months after his discharge from the military. At his initial appointment in October 1999, the Veteran filled out a questionnaire where he reported having back, knee, and leg cramps that began in 1988 and was due to overuse of back muscles. The questionnaire specifically asked if the condition was related to an auto accident, and it asked if the Veteran had a past history of any major accidents or falls. The Veteran did not report the purported MVA from 1997. The May 2019 VA examiner found that the Veteran’s back pain and subsequent chiropractic treatment from October 1999 to 2000 was likely due to his physically demanding civilian employment. As to the Veteran’s back condition being related to an undiagnosed illness due to his service in Southwest Asia. The May 2019 VA examiner found that the Veteran’s current back condition of degenerative disc disease had a clear and specific etiology and diagnosis. The Board notes that the VA examiner in the May 2019 VA medical opinion provided a highly detailed, thorough, and well rationalized opinion, which the Board finds to provide great probative value. Consideration is given to the Veteran’s contention that his claimed back disability was incurred in or caused by his military service. While lay persons are competent to provide opinions pertaining to certain medical issues, the etiology of a back disability such as degenerative disc disease, as is specific to this case, is outside the realm of common knowledge for someone, such as the Veteran, who does not possess medical training, specialized expertise, or experience. Jandreau v. Nicholson, 492. F.3d 1372, 1377 n.4 (Fed. Cir. 2007). While the Veteran would be considered competent to report a MVA during service, as discussed above his accounts are not found to be credible. As such, service connection for a back disability, to include as due to an undiagnosed illness relating to service in Southwest Asia, is not warranted and the claim is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Lutgens-Staley, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.